Operational Success Stories: Unit-Based Teams Getting Results

1. How unit-based teams are getting results Examples of operational success December 2013

2. Patient safety: No one walks alone FEATURED TEAM Telemetry, San Diego (Southern California) WHAT THEY DO By viewing every patient—not just some—as fall risks, this telemetry UBT successfully piloted a falls-reduction initiative that has drastically decreased falls hospital-wide. RESULTS Falls in a month Visit LMPartnership.org for ideas and tools for your team.

3. UBT roots out workplace injury mystery FEATURED TEAM Radiology, Redwood City (Northern California) WHAT THEY DID When workplace injuries started cropping up among technologists in Redwood City’s radiology department, UBT members worked with the manufacturer of the newly installed mammography equipment to make the machine easier to use. They also worked with ergonomic consultants to learn techniques for preventing repetitive movement injuries. RESULTS Reduction in workplace injuries Visit LMPartnership.org for ideas and tools for your team.

4. Rx refill center boosts efficiency, cuts waste • FEATURED TEAM • Automated Refill Center at Pharmacy Distribution Center (Georgia) • WHAT IT DID • To reduce costs and the time it takes to stock medications that come in a variety of sizes, pharmacy workers: • Order items in same-size packages (except for two antibiotics that come in specific quantities that clinic staff found useful) • Stock items only in the largest containers available to reduce waste. RESULTS Visit LMPartnership.org for ideas and tools for your team.

5. Total Health: Counting the time pays off FEATURED TEAM Family Medicine, San Mateo (Northern California) WHAT THEY DID This UBT got its members up and moving with a little friendly competition, forming small teams with four or five people. The teams tracked how much total exercise they did each week, and the ones that logged the most minutes or days of exercise won prizes. Staff members reported that the wellness activity lowered stress levels, got them in better shape and improved teamwork. RESULTS Approximate employee participation Visit LMPartnership.org for ideas and tools for your team.

6. Vision team sees way to cut supply costs • FEATURED TEAM • Vision Essentials, Wheatridge Medical Office (Colorado) • WHAT IT DID • To reduce the cost of excess inventory of medications, the team: • Reviewed all standing supply orders • Tracked the cost and number of items ordered for on-hand pharmaceutical use • Consulted with providers and reduced the amount and cost of ordered and stocked pharmaceuticals. RESULT UBT reduced cost of on-hand pharmaceuticals by 69 percent Visit LMPartnership.org for ideas and tools for your team.

7. Lab reduces waste, wait times and unneeded tests FEATURED TEAM Laboratory, Skyline Medical Office (Northwest) WHAT IT DID Saw an opportunity to save time and money by addressing a systems issue: Orders from Oncology were marked as “standing” so tests were repeated—even if a patient did not need the same tests done each time. Forty-five percent of tests done between February and June 2013 turned out to be unnecessary. Collaborated with Oncology to start using a “golden ticket” to identify the specific tests a patient needs and expedite the process when patients go to the lab for their blood draw. RESULT Team avoided processing 65 unneeded tests in four months, for annualized savings of $23,500 Visit LMPartnership.org for ideas and tools for your team.

8. Patient education helps wait times plummet • FEATURED TEAM • Oncology Clinic, Moanalua Medical Center (Hawaii) • WHAT IT DID • To decrease wait times and sustain service improvement over time, this team: • Advised patients to complete lab work at least one or two days in advance of their appointments • Recruited medical assistants to help physicians track lab orders and ensure lab tests are completed • Restricted most same-day appointments to treatments lasting 60 minutes or less, and reserved a two-hour window for lengthy appointments that cannot be postponed due to a patient’s schedule • Staggered patient appointment times to address staffing shortfalls. RESULT Average daily patient wait time Visit LMPartnership.org for ideas and tools for your team.

9. Meeting the KP.org challenge • FEATURED TEAM • Point Loma Primary Care, Module B (Southern California) • WHAT IT DID • To increase patient and members’ enrollment in kp.org, this team: • Involved all UBT members in efforts to sign up health plan members on kp.org • Posted signs at the registration kiosk encouraging sign-ups • Used patient visits , elevator wells and waiting areas to the lab, radiology and pharmacy as opportunities for sign-ups • Took advantage of “smart phrases”—short, standardized scripts—in KP HealthConnect to prompt caregivers to discuss kp.org with patients. RESULT KP.org enrollment Visit LMPartnership.org for ideas and tools for your team.

10. Scanning team reduces patient record errors • FEATURED TEAM • Scanning, Fresno Medical Center (Northern California) • WHAT IT DID • The team significantly reduced average errors rates in just six months by: • Tracking, graphing and posting department-wide errors monthly • Changing workflow to check for errors at each step of the process • Huddling regularly to review errors and discuss potential solutions • Reducing the number of patient records processed at a time. RESULT Average errors per month Visit LMPartnership.org for ideas and tools for your team.

11. Storytelling helps with early cancer detection • FEATURED TEAM • Primary Care, North Lancaster Medical Office (Northwest) • WHAT IT DID • To increase the number of members completing the home test for colorectal cancer, this team: • Identified members between the ages of 50 and 75 eligible for colorectal cancer screening • Scripted a story about how physicians in the clinic had tested positive—but because the disease was detected early, they got treatment in time and are doing well • Tracked distribution of the kits and followed up with members who hadn’t returned them. RESULT The return rate for take-home fecal immunochemical tests (FIT) kits Visit LMPartnership.org for ideas and tools for your team.

12. Communication among teams improves mammogram rates • FEATURED TEAM • Adult Medicine, Shady Grove Medical Center • (Mid-Atlantic States) • WHAT IT DID • This UBT in Rockville, Md., worked with Primary Care and Radiology to resolve scheduling conflicts that caused patients to be turned away from same-day mammogram appointments. The team: • Worked with Radiology on a process for sharing schedule information so the best days and times for same-day mammograms can be identified • Set clear boundaries. For example, the Adult Medicine unit agreed not to send patients for mammograms after 3:45 p.m., when one radiology technician is trying to close out the day’s appointments without incurring overtime. RESULT Mammogram screening rate Visit LMPartnership.org for ideas and tools for your team.

13. Getting to zero pressure ulcers • FEATURED TEAM • Respiratory Care, San Jose Medical Center (Northern California) • WHAT IT DID • To reduce reportable hospital-acquired pressure ulcers (HAPUs), the team set a goal of sustaining at least a 90 percent completion rate for patient skin assessments . They did this by: • Conducting four skin integrity assessments per patient during each 12-hour shift • Documenting observations in patient charts • Electronically tracking assessments on a weekly basis • Auditing assessments on a monthly basis • Posting results with names of corresponding respiratory therapists • Providing counseling and encouragement for those not meeting the goal. RESULT Reportable HAPUs Visit LMPartnership.org for ideas and tools for your team.

14. Transforming transport • FEATURED TEAM • Adult Medicine, Capitol Hill Medical Center (Mid-Atlantic States) • WHAT IT DID • To reduce staff time spent transporting patients by wheelchair from the unit to the lab, pharmacy, hospital entrance or public transit stop, the team: • Tracked transport times by staff members • Obtained new, wider wheelchairs to accommodate more patients • Coordinated transport times with other departments • Created and staffed a dedicated transporter position. RESULT Patient transport times (minutes) Visit LMPartnership.org for ideas and tools for your team.

15. Lab gets quicker on the draw • FEATURED TEAM • Infectious Disease/Oncology UBT • (Northern California) • WHAT IT DID • To shorten wait times for blood draws, this Gilroy Medical Offices UBT: • Shifted staff schedules so the lab opens earlier • Staggered lunch breaks to spread out the loss of staff on the floor • Educated physicians to improve the clarity of lab orders and reduce duplicative orders • Cross-trained staff members so everyone can register patients and process specimens as well as draw blood. If eight or more patients are waiting to have blood drawn, the team goes into “all hands on deck” mode. RESULT Average daily wait time (minutes) Visit LMPartnership.org for ideas and tools for your team.

16. Standing together to prevent patient falls • FEATURED TEAM • Ortho/Neuro Surgical UBT • (Southern California) • WHAT IT DID • To radically reduce the number of patients who fall, the team at Fontana Medical Center conducted several tests of change, including: • Calendar posts to make problems known to all when they occur, whether day shift or night shift • Daily huddles include a patient safety briefing to air concerns or potential problems • Blame-free debriefings after a fall to discuss what happened and how to prevent it • Quick response to bed alarms indicating that a patient has gotten up. RESULT Patient falls decreased by nearly 40 percent Visit LMPartnership.org for ideas and tools for your team.

17. Medication reconciliation keeps patients safe • FEATURED TEAM • Infectious Disease/Oncology UBT • (Georgia) • WHAT IT DID • To reduce duplicate medications listed in patient records, members of this team at the Cumberland Medical Office Building in Atlanta started by manually cleaning up patient charts. Then they instituted a new process for checking medications: • Licensed practical nurses and medical assistants ask patients to bring their medications to office visits • MAs and LPNs review patient medications and note on member’s chart which ones the patient is or is not taking • Providers confirm medications with the member and remove the duplicate oncology medication from the patient’s record • MA prints out the patient’s medications and gives the list to the nurse practitioner who, with the clinical pharmacist, reviews it and removes expired medications. RESULT Percent of duplicate medications per office visit Visit LMPartnership.org for ideas and tools for your team.

18. Assigning ownership of surgical instruments saves thousands FEATURED TEAM Head and Neck Surgery (Colorado) WHAT IT DID To reduce the number of surgical instruments lost before and after surgeries, nurses in this Franklin Medical Office UBT in Colorado now “own” a set of instruments. Team members are responsible for counting the instruments at the beginning and the end of the day, similar to reconciling a cash box in a retail environment. RESULT The number of lost or broken instruments Visit LMPartnership.org for ideas and tools for your team.

19. Team improves nutrition service while cutting waste • FEATURED TEAM • Food and Nutrition department • (Northern California) • WHAT IT DID • This San Jose Medical Center team identified ways to prevent costly food waste, where unused formula, supplements and food end up in the garbage. Small tests of change included: • Conducting a “wasted meal study” to learn how much money was being lost to unused meals ($16,000 a year) • Improving communication with unit assistants about patients’ eating patterns and discharge data • Paying closer attention to expiration dates on supplements and adjusting the ordering accordingly. RESULT Monthly food expenses cut by 10 percent Visit LMPartnership.org for ideas and tools for your team.

20. UBT helps new members navigate KP • FEATURED TEAM • Adult Primary Care, Falls Church • (Mid-Atlantic States) • WHAT IT DID • To improve member retention and help Kaiser Permanente grow, members of this UBT: • Involved Spanish-speaking staff in welcoming 3,200 new Spanish-speaking members • Used the New Member Identifier tool in KP HealthConnect™ so staff could help orient new members, or those who haven’t been in for a while • Called new members to set up appointments, help refill prescriptions and address other needs • Sent welcome letters and a road map on how to get started as a Kaiser Permanente member and patient • Passed out a new member kit with contact numbers. RESULT Favorable patient satisfaction scores Visit LMPartnership.org for ideas and tools for your team.

21. Wait times down, courtesy scores up • FEATURED TEAM • Laboratory • (Northwest) • WHAT IT DID • To cut wait times that could sometimes exceed 45 minutes, the Mt. Scott Medical Office lab moved to a one-on-one model in which: • A technician stays with each patient from check-in to blood draw • The technician returns to the check-in desk to take the next patient • More team members are freed up to reduce the queue, rather than having a dedicated member working the computer. RESULT Improved patient satisfaction and an unexpected jump in technician courtesy scores Visit LMPartnership.org for ideas and tools for your team.